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Please provide your contact information

Study/project title

Institutional Review Board (IRB) approval date (mm/dd/yyyy; you may return to this survey and complete this section once your study is approved)

IRB #

If you are not the principal investigator (PI), please provide PI information here:

First name

Last name

Degree(s)

License(s)

Certification(s)

Telephone #

Email address

Institutional title

Unit/Department

Study status

Please provide name and email for any additional nurses involved in this study as key study personnel.

Study scope

Study type

Original

Replication

Methods

Qualitative

Quantitative

Mixed methods

Unit(s) involved

Have you contacted the Unit manager(s) regarding your proposed research? We appreciate your efforts to inform nurses about research in patient care areas prior to initiating your study. Please contact the Center for Nursing Science if you need assistance to identify the appropriate contacts.

Yes

No

Thank you for completing this information. Please assure that a copy of your research proposal is sent to the Center for Nursing Science. Your IRB Administrative Approval form (HRP-226) should be submitted with the proposal for review prior to signature. Please provide at least three business days for review and signature. You will be notified upon document completion so that you can pick them up from the Center for Nursing Research. Note that upon study completion, a report of study findings and plan for dissemination should be submitted to the Center for Nursing Science. Direct any questions to Lori Kennedy Madden, PhD, RN, ACNP-BC, CCRN, CNRN, lkmadden@ucdavis.edu, 916.703.3021.